Report: Kasich’s exchange leaves money on the table

There are two recent studies on Obamacare exchanges that shed light on Ohio’s insurance market. They both show that uninsured Ohioans will be getting a better deal, and that there’s plenty of room for improvement.

The higher the Silver premium, the larger the subsidy. If the subsidy is higher than the Bronze premium (as with the 60-year olds above), then the Bronze plan is free.

Of the 18 states studied, Ohio is in the middle of the pack on each of these prices. What I’m relieved to find is a decent price difference between Silver and Bronze plans, though it would be good to make that larger.

South Dakota, for instance, has completely screwed up its exchange. Its Bronze premiums are only $19 less than its Silver premiums, so the Bronze plan gets almost no discount.

Vermont, on the other hand, has a $140 difference between Bronze and Silver plans. That means that basically everybody can get a Bronze plan for free, because the tax credit is greater than the cost of the Bronze plan.

That means that most Vermonters on the exchange will get an extra $1452 each year from the federal government simply because of their price structure.

Vermont accomplishes this through an Active Purchaser Exchange, meaning that they only include particular plans. This lets them manage after-tax premiums a lot more closely.

Now, premium costs are much higher for higher-income uninsured Vermonters ($336) than for higher-income uninsured South Dakotans ($239). But most people earning that much money get insurance through their work; my estimate (which is backed by both of these studies) is that 88% of uninsured Ohioans will qualify for subsidies or Medicaid.

Depending on the results of the open enrollment period, both gubernatorial candidates could very easily promise to lower exchange prices for the majority of enrollees. Let’s say that the Kaiser plan isn’t very popular2 and that the next plan costs $226 instead of $196. By simply dropping the Kaiser plan, the majority of exchange users would save $30 a month. The only people hurt by that would be people enrolled in the Kaiser plan who don’t get subsidies.

In fact, I’d go so far as to say that the governor has a duty to keep after-tax insurance costs low, and in the managed competition of Obamacare has a fantastic lever to do so. It’s just that one of the candidates has said Obamacare is the worst thing in world history, and the other candidate can show how 60-year olds in Maryland are paying half as much as Ohioans, or how 40-year old women in Connecticut are paying 25% less. Running the exchange is part of a governor’s job description, and the governors of Oregon, Maryland, and Connecticut are doing it better than Kasich.

The final very, very good news is that the original CBO score for Obamacare anticipated Silver plans of $320. 15 of the 18 states cost less than that, including California (the most populous state). This means that Obamacare will probably cost way, way less than anticipated.

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A week prior, Rand Corporation estimated the impact of Obamacare on health expenditures and on the population getting insurance. It was a rather disappointing study, because it didn’t look at actual insurance premiums, it looked at estimated health costs. Very importantly, it found that prices for small businesses would be unchanged, but 23% of small business workers would be eligible for tax credits.

It also concluded that most uninsured Ohioans would have coverage by 2016, and that overall individual health expenditures would drop 21% after subsidies, earning a nice headline in the Plain Dealer. PD went on to compare that “average premium” to the current “average premium”, which is unfortunately a made-up statistic.

To analogize, ODI found “the average of premiums on the insurance market” the way one would find “the average rushing yardage of a Browns player”. They had 12 runners gain 1593 yards last year; so the “average runner” gained 133 yards all season. Therefore, we should expect Trent Richardson to rush for 8 yards each game3.

It’s a statistic that tells us about the number of plans on the market, but tells us nothing about the cost of each plan.

The Kaiser report is, to date, the best comparison of exchanges (while the Rand report shows that the prices are sustainable). These are the documents that, moving forward, will tell governors what they can do to best serve their population by getting the best deals for Ohioans who buy on the exchange.

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1 So, “people who need health services” get the resources, rather than “people who can afford health services”. Insurance redistributes resources from “people who have something but don’t need it right now” to “people who need something right now but can’t buy it”. When it’s something that we’ll all need someday (health care, recovery from accidents

2 The provider network will be the determinant here. I’d expect Kaiser to have a good network–indeed, I expect this plan to completely dominate the market–but I could be totally wrong. Also, I’d expect that at least one of the 16 regions will have a Silver plan with a lousy network.

3 I wish I’d thought of this a year ago, because it’s a great analogy.

We only care about 1 or 2 runners on the Browns, because they get 90% of the carries. Similarly, we only care about a handful insurance plans that meet our needs while charging the least.

ODI has fixated on these $50/month plans with no prescription coverage and $25,000 deductibles, even though very few people are enrolled in them (and those who are, are being ripped off). They’re judging the Browns rushing attack on Thad Lewis’ one carry for 3 yards. The Chudzinski era won’t last long if their backup quarterback can’t average at least 4.5 yards a carry!